Reducing suicide and suicide attempts in adolescents are two of the health promotion and disease prevention objectives of Healthy People 2010. Despite the morbidity and mortality associated with suicide attempts in adolescents, we lack empirically supported treatment strategies and consensus regarding best practices. This proposal aims to address this critical public health problem by developing, piloting, and evaluating an intervention protocol aimed specifically at preventing repeat and potentially lethal suicide attempts. The work involves two phases. During Phase 1, we will develop and pretest the intervention manuals and protocol, training and quality assurance protocols, and adherence measures with 25 youth. In Phase 2, we will randomly assign 60 youth to the SAFETY Intervention (n=30) or Usual Care (n=30). The SAFETY Intervention is an individually tailored intervention strategy that integrates: 1) family and community based interventions aimed at mobilizing family and community networks that support youth safety, adaptive behavior, and reasons for living, and decreasing factors contributing to suicidality; 2) cognitive-behavioral treatment modules that focus on decreasing suicidality and preventing repeat suicide attempts; and 3) an individualized care linkage strategy that links youth to needed services and resources. Outcomes are monitored at 3- and 6-month follow-up assessments, by evaluators who are blinded to intervention condition. Primary outcomes are: hospitalizations; incidence of repeat suicide attempts; and youth and parent satisfaction with mental health services. Secondary outcomes are: youth depression; hopelessness; reasons for living; mental health related quality of life; and parent/caregiver emotional well being. We examine potential moderators (e.g. depression, age, gender, ethnicity) and mediators (reasons for living, hopelessness, depressive symptoms, family conflict, social support) of treatment response. To anticipate key issues that are important for intervention feasibility and effectiveness under usual practice conditions and eventual community adoption, we include partners from community mental health programs in the treatment development process. This project aims to further develop and conduct a preliminary evaluation of the SAFETY Program, an intervention aimed at preventing suicide and suicide attempts in adolescents. Suicide is the third leading cause of death among adolescents and reducing suicide and suicide attempts in adolescents are two of our national health promotion and disease prevention objectives (Healthy People 2010, Office of Disease Prevention and Health Promotion, 2000). [unreadable] [unreadable] [unreadable]